Kathleen E Gray, ARNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

ARNP2844802 Issued in FL

Practice address

1636 Shadowood LN Ste 120
Jacksonville, FL 32207-2187

Phone

(904) 725-9701

Fax

(904) 725-9694

NPI assigned

Mar 20, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1851407365
  Medicare reassignment NPD
• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1376216945
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1124393418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19249",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322459249",
            "telephone_number": "904-743-1883",
            "fax_number": "904-743-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 SHADOWOOD LN STE 120",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072187",
            "telephone_number": "904-725-9701",
            "fax_number": "904-725-9694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "KATHLEEN",
        "middle_name": "E",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-20",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "ARNP2844802",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP2844802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7663463",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Lynn Gray, PT, DPT, M ED
• Haley Skye Pfitzner Gray
• Jennifer Gray
• Josepf Gray
• Juan A Gray, MSW
• Monica Gray
• Noel W Gray, DC
• Shawn Ryan Gray, LCSW
• Shelley Gray, DNP, FNP-C
• Tameka Gray

• Psychiatric/Mental Health Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.